In October 2015, Santé publique France was commissioned by the Directorate General for Health (DGS) to assess the feasibility of establishing an epidemiological surveillance system in the industrial area of Lacq (Pyrénées-Atlantiques).
In response to this request, Santé publique France developed a multi-step approach: an assessment of expectations and the local context, two epidemiological studies, and a self-reported health survey.
The analysis of the social context, the first part of this work, is being released today.

Why this request?

The Lacq industrial basin, located in the Pyrénées-Atlantiques northwest of Pau, is a vast industrial complex that emerged in the 1950s around a natural gas field. In the 2000s, an epidemiological study conducted by the University of Bordeaux showed an excess mortality rate among residents in the area near the industrial site compared to more distant control areas, among people under 65 years of age, for all causes combined and due to cancer.
In 2015, Santé publique France was tasked by the DGS following an interim ruling by the Court of Auditors regarding the health safety of this industrial basin and a strong local mobilization of elected officials and citizens.

Initial results of a multi-stage approach: analysis of the local context

The objective of the study of the local context published today was to identify the perceptions and expectations of various local stakeholders regarding the links between health and the environment around the industrial site. It was conducted through interviews with a diverse range of local stakeholders (residents, associations, employees, healthcare professionals, industrialists, local elected officials, and government representatives).

Several key findings can be drawn from this study:

• The employment/economy issue is a major concern for all those interviewed.

• The health/environment issue appears to be a growing concern, with varying levels of anxiety and perceptions of health risks depending on the stakeholders interviewed:

  • Residents express a certain mistrust toward the factories, particularly when certain symptoms or conditions arise (irritations, respiratory issues, nausea, thyroid disorders, etc.);

  • The two main local associations (Sepanso and Arsil) bring these concerns to the public sphere through various actions (legal, media, public meetings). A request was made to assess the frequency of certain symptoms or conditions not included in the databases used by epidemiologists. The associations express mistrust toward health authorities and industry, and a desire to be informed about how epidemiological studies are conducted;

  • Healthcare professionals perceive an excess of respiratory, digestive, hematological, and thyroid conditions, particularly affecting children and workers. They would like to be better informed by health authorities and industry representatives on the issue of pollutants and their impact on health, and to collaborate more closely with occupational health representatives;

  • Unions and occupational physicians perceive an excess of solid tumors and leukemias among employees in the Lacq industrial basin. They report underreporting by the employees themselves, who fear losing their jobs;

  • Industrial operators cite an overall improvement in the situation compared to the site’s early years of operation, with the cessation of discharges (liquid effluents) into the soil, the initiation of decontamination operations, and a reduction in atmospheric emissions. In their view, the results of air quality measurements show no cause for concern.

Taking into account lessons from the local context

Following these findings, a number of measures have been or will be implemented by Santé publique France and/or the Regional Health Agency. The health conditions reported by residents, healthcare professionals, and community organizations have been incorporated into the ongoing morbidity study. A training program for local healthcare professionals will be organized. The participatory self-reported health survey will be implemented with earlier involvement of local stakeholders.

The two epidemiological studies (mortality study and exploratory morbidity study) are currently underway and will be the subject of a forthcoming publication.